Concordance with national guidelines for colorectal cancer care in New South Wales: a population-based patterns of care study

Med J Aust. 2007 Mar 19;186(6):292-5. doi: 10.5694/j.1326-5377.2007.tb00903.x.

Abstract

Objective: To investigate predictors of evidence-based surgical care in a population-based sample of patients with newly diagnosed colorectal cancer.

Design, patients and setting: Prospective audit of all new patients with colorectal cancer reported to the New South Wales Central Cancer Registry between 1 February 2000 and 31 January 2001.

Main outcome measures: Concordance with seven guidelines from the 1999 Australian evidence-based guidelines for colorectal cancer; predictors of guideline concordance; the mean proportion of relevant guidelines followed for individual patients.

Results: Questionnaires were received for 3095 patients (91.6%). Between 0 and 100% of relevant guidelines were followed for individual patients (median, 67%). Concordance with individual guidelines varied considerably. Patient age independently predicted non-concordance with guidelines for adjuvant therapy and preoperative radiotherapy. Adjuvant chemotherapy was more likely if a patient with node-positive colon cancer was treated in a metropolitan hospital or by a general surgeon. Surgeons with a high caseload or specialty in colorectal cancer were more likely to perform colonic pouch reconstruction, prescribe thromboembolism or antibiotic prophylaxis, and were less likely to refer patients with high-risk rectal cancer for adjuvant radiotherapy. Bowel preparation was less likely among older patients and in high-caseload hospitals.

Conclusion: Effective strategies to fully implement national colorectal cancer guidelines are needed. In particular, increasing the use of appropriate adjuvant therapy should be a priority, especially among older people.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Antineoplastic Agents / therapeutic use*
  • Colectomy / methods*
  • Colorectal Neoplasms / drug therapy
  • Colorectal Neoplasms / radiotherapy
  • Colorectal Neoplasms / surgery
  • Colorectal Neoplasms / therapy*
  • Female
  • Guideline Adherence*
  • Humans
  • Male
  • Meta-Analysis as Topic
  • Middle Aged
  • New South Wales
  • Outcome Assessment, Health Care / methods*
  • Patient Compliance
  • Population Surveillance*
  • Practice Guidelines as Topic*
  • Prospective Studies
  • Radiotherapy, Adjuvant / standards
  • Risk Factors
  • Societies, Medical

Substances

  • Antineoplastic Agents